BMJ feature – Preventing Overdiagnosis: how to stop harming the healthy

“Preventing overdiagnosis: how to stop harming the healthy,” is a feature in this week’s BMJ by Ray Moynihan, Jenny Doust and David Henry.

I won’t try to recapture the entire piece in this blog because you should read it yourself.

But here are section headings:

• Screening detected overdiagnosis
• Increasingly sensitive tests
• Incidentalomas
• Excessively widened definitions (of disease)
• Examples of overdiagnosis

• Asthma—Canadian study suggests 30% of people with diagnosis may not have asthma, and 66% of those may not require medications

• Attention deficit hyperactivity disorder—Widened definitions have led to concerns about overdiagnosis; boys born at the end of the school year have 30% higher chance of diagnosis and 40% higher chance of medication than those born at the beginning of the year

• Breast cancer—Systematic review suggests up to a third of screening detected cancers may be overdiagnosed

• Chronic kidney disease—Controversial definition classifies 1 in 10 as having disease; concerns about overdiagnosis of many elderly people

• Gestational diabetes—Expanded definition classifies almost 1 in 5 pregnant women

• High blood pressure—Systematic review suggests possibility of substantial overdiagnosis

• High cholesterol—Estimates that up to 80% of people with near normal cholesterol treated for life may be overdiagnosed

• Lung cancer—25% or more of screening detected lung cancers may be overdiagnosed

• Osteoporosis—Expanded definitions may mean many treated low risk women experience net harm

• Prostate cancer—Risk that a cancer detected by prostate specific antigen testing is overdiagnosed may be over 60%

• Pulmonary embolism—Increased diagnostic sensitivity leads to detection of small emboli. Many may not require anticoagulant treatment

• Thyroid cancer—Much of the observed increase in incidence may be overdiagnosis

 

They also announced that “Next year, an international scientific conference called Preventing Overdiagnosis aims to deepen understanding and awareness of the problem and its prevention. The conference will take place on 10-12 September 2013 in the United States, hosted by the Dartmouth Institute for Health Policy and Clinical Practice in partnership with the BMJ, the leading US consumer organisation Consumer Reports, and Bond University. ”